Automatically labeling data using natural language processing

ABSTRACT

In an illustrative embodiment, methods and systems for automatically labeling unstructured data include accessing unstructured data representing data entry and analyzing the unstructured data by applying natural language processing to a text component of the unstructured data to obtain a set of term counts of words and/or phrases identified in the text component. Analyzing may include applying at least one clustering algorithm to the set of term counts to determine a term cluster, identifying a preexisting term cluster most closely matching the term cluster, and applying, to the unstructured data, a predefined label corresponding to the preexisting term cluster. The unstructured data may be analyzed to obtain formatting counts of formatting elements, and a formatting cluster may be determined and applied to match to a preexisting formatting cluster, thus deriving a predefined label corresponding to the preexisting formatting cluster.

RELATED APPLICATIONS

This application claims priority to U.S. patent application Ser. No.17/666,001, entitled “Automatically Labeling Data using Natural LanguageProcessing” and filed Feb. 7, 2022, (now U.S. Pat. No. 11,544,795) whichclaims priority to U.S. Provisional Patent Application Ser. No.63/147,348, entitled “Automatically Labeling Data using Natural LanguageProcessing” and filed Feb. 9, 2021.

This application is related to the following prior patent applications:U.S. patent application Ser. No. 16/720,460, entitled “Systems, Methods,and Platforms for Automated Quality Management and Identification ofErrors, Omissions and/or Deviations in Coordinating Services and/orPayments Responsive to Requests for Coverage under a Policy,” filed Dec.19, 2019 (now U.S. Pat. No. 10,977,738). All above identifiedapplications are hereby incorporated by reference in their entireties.

BACKGROUND

Complex insurance claims have historically been monitored manually,resulting in oversights and errors that can lead to financial loss,reduction in customer satisfaction, and frustration for processing agentteams. Because of the overwhelming amount of information, oversight andreview of the claims process by supervisors of processing agents hastypically been spotty, and selection of which individual claims toreview has involved the supervisor's subjective belief, or intuition, onwhich claims are most likely to lead to complications and/or loss aswell as coarse objective measures such as reserve amount or reviewchecklists. The claims financial improvement opportunity of an averageinsurer is typically 8-12% of claims loss and allocated loss adjustmentexpenses (ALAE) costs, depending on the line of business. However, todate, insurers have had limited strategies or knowledge on how to reducefinancial improvement opportunity. The inventors recognized a need forautomated, objective analysis of claims handling, while the claims arestill being processed, to identify potential monetary or customersatisfaction losses and to activate automatic and/or manualinterventions to stem or avert loss.

SUMMARY OF ILLUSTRATIVE EMBODIMENTS

In one aspect, the present disclosure describes methods, systems, and aplatform for assessing and analyzing the quality of claims handlingrelative to best practices. The methods and systems may be applied, forexample, to provide front line and executive management of insurancecompanies with the tools and resources needed to drive continuous,measurable improvement in claim handling behaviors and claim outcomes.

In one aspect, the present disclosure describes methods, systems, and aplatform for identifying high risk claims during the claims processingcycle. The methods and systems described herein can be used to identifyhandling patterns and best practice deviations resulting inopportunities for improvement in customer service, operationalefficiency, and indemnity results. By identifying potential problems,resources may be delegated to assess the claims handling process and toavert losses.

In support of assessing claims handling, in some implementations,unstructured data portions of information attached to claims areanalyzed to automatically apply labels identifying information types,actions taken, and/or follow-up tasks to be performed. The unstructureddata portions, in some examples, can include claims agent notes, legaldocuments, photos, invoices, police reports, and other documentationrelated to claims processing. Natural language processing techniques canbe applied to the unstructured data portions to analyze the content inview of formatting and/or terminology used. For example, one or moreclustering algorithms may be applied to format, word, and/or phrasecounts to compare a given unstructured data portion to other, labeled,unstructured data portions to find matches and, optionally, near matchesor close similarity between cluster analysis of a given unstructureddata portion and previously labeled unstructured data.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate one or more embodiments and,together with the description, explain these embodiments. Theaccompanying drawings have not necessarily been drawn to scale. Anyvalues dimensions illustrated in the accompanying graphs and figures arefor illustration purposes only and may or may not represent actual orpreferred values or dimensions. Where applicable, some or all featuresmay not be illustrated to assist in the description of underlyingfeatures. In the drawings:

FIG. 1 is a block diagram of an example system for applying naturallanguage processing to automatically label unstructured data within aninsurance claims environment;

FIG. 2A is a flow chart of an example method for assigning unstructureddata portions to clusters;

FIG. 2B is a flow chart of an example method for identifyingsupplemental data related to unstructured data portions;

FIG. 2C is a flow chart of an example method for analyzing clusterassignments to automatically label unstructured data portions;

FIG. 3 is an example data entry screen for capturing an unstructureddata portion;

FIG. 4 is a flow diagram of an example process for trainingvulnerability detection data models using information derived fromunstructured data portions;

FIG. 5 is a block diagram of an example computing system; and

FIG. 6 is a block diagram of an example distributing computingenvironment including a cloud computing environment.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

The description set forth below in connection with the appended drawingsis intended to be a description of various, illustrative embodiments ofthe disclosed subject matter. Specific features and functionalities aredescribed in connection with each illustrative embodiment; however, itwill be apparent to those skilled in the art that the disclosedembodiments may be practiced without each of those specific features andfunctionalities.

Reference throughout the specification to “one embodiment” or “anembodiment” means that a particular feature, structure, orcharacteristic described in connection with an embodiment is included inat least one embodiment of the subject matter disclosed. Thus, theappearance of the phrases “in one embodiment” or “in an embodiment” invarious places throughout the specification is not necessarily referringto the same embodiment. Further, the particular features, structures orcharacteristics may be combined in any suitable manner in one or moreembodiments. Further, it is intended that embodiments of the disclosedsubject matter cover modifications and variations thereof.

It must be noted that, as used in the specification and the appendedclaims, the singular forms “a,” “an,” and “the” include plural referentsunless the context expressly dictates otherwise. That is, unlessexpressly specified otherwise, as used herein the words “a,” “an,”“the,” and the like carry the meaning of “one or more.” Additionally, itis to be understood that terms such as “left,” “right,” “top,” “bottom,”“front,” “rear,” “side,” “height,” “length,” “width,” “upper,” “lower,”“interior,” “exterior,” “inner,” “outer,” and the like that may be usedherein merely describe points of reference and do not necessarily limitembodiments of the present disclosure to any particular orientation orconfiguration. Furthermore, terms such as “first,” “second,” “third,”etc., merely identify one of a number of portions, components, steps,operations, functions, and/or points of reference as disclosed herein,and likewise do not necessarily limit embodiments of the presentdisclosure to any particular configuration or orientation.

Furthermore, the terms “approximately,” “about,” “proximate,” “minorvariation,” and similar terms generally refer to ranges that include theidentified value within a margin of 20%, 10% or preferably 5% in certainembodiments, and any values therebetween.

All of the functionalities described in connection with one embodimentare intended to be applicable to the additional embodiments describedbelow except where expressly stated or where the feature or function isincompatible with the additional embodiments. For example, where a givenfeature or function is expressly described in connection with oneembodiment but not expressly mentioned in connection with an alternativeembodiment, it should be understood that the inventors intend that thatfeature or function may be deployed, utilized or implemented inconnection with the alternative embodiment unless the feature orfunction is incompatible with the alternative embodiment.

FIG. 1 is a block diagram of an example system 100 for applying naturallanguage processing to automatically label unstructured data within aninsurance claims environment. In some implementations, a claimsprocessing platform 102 includes a number of software programs,algorithms, routines, or other computer logic-implemented features,referred to generally as “engines”, for processing claims informationand applying labels to unstructured data portions so that actionsassociated with the labels can be tracked, assigned, or followed up onwith claims processing agents 108, for example to ensure that claimsprocessing milestones are adhered to and claims leakage is averted. Theclaims information may be obtained from one or more claims sources 106,such as notes submitted by the claims processing agents 108, reportssubmitted by police or other officials, and/or legal documents generatedin relation to an insurance claim. A portion of the claims information,in some embodiments, is imported from one or more clients 104. Further,the clients 104 may include supervisors, managers, board members, orother staff involved in processing the claim or overseeing claimsprocessing by the claims agents 108.

In some embodiments, the claims information and other data is stored ina data repository 110 that may include one or more data stores,cloud-based data pools, databases, or other non-transitory computerreadable storage mediums for collecting and storing various types offiles and other information.

Turning to the claims processing platform 102, in some implementations,portions of unstructured claims data such as, in some examples,claim-related notes 148, claim-related legal documents 150, andclaim-related handwritten materials 152 are provided to an unstructureddata processing engine 114 for analyzing the contents and categorizingthe unstructured material. The unstructured data processing engine 114,for example, may coordinate the processing and analysis of theunstructured data portions with other engines of the claims processingplatform 102, resulting in data labeling (e.g., via an automaticlabeling engine 120) and/or action assignment (e.g., via an actionassignment engine 122). In an illustrative example, the unstructureddata portions may each represent information regarding what needs to bedone (e.g., a follow-up with an insurance company, etc.), what has beendone (e.g., information sent to a client, etc.), and/or analysisregarding elements of the insurance claim during the processing cycle ofan insurance claim.

In some implementations, the unstructured data processing engine 114conducts pre-processing of the unstructured data portions such as, insome examples, natural language processing (NLP) recognition ofhandwritten data, text cleaning, recognition of abbreviations, removalof non-alphabet characters or non-alphanumeric characters, conversioninto a single verb tense, tokenization, normalization, and/or noiseremoval. Further, the unstructured data processing engine 114 mayconvert various types of data sources (e.g., file types) into a singleformat for further analysis. For example, the unstructured data portionsmay be transformed into consistent document data 158. If the originaldocument type contained a metadata portion, the unstructured dataprocessing engine 114 may store the metadata as document metadata 160.If the original document is stored in a graphical format (e.g., .pdffile), audio format (e.g., .wav file), or video format (e.g., .movfile), written and/or audible words may be transformed into text forfurther analysis.

The unstructured data processing engine 114, in some implementations,provides the unstructured data portion(s) to a format clustering engine116 for formatting analysis. The formatting of unstructured dataportion(s), for example, may be useful in identifying unstructured datatypes that include a consistent structure, such as automaticallygenerated notes, note templates for logging common information, and/ororganizational and/or supervisor trained note styles.

An example user interface 300 for entering a claim note 304 related toan insurance claim is illustrated in FIG. 3 . Turning to FIG. 3 , thetext of the claim note, as illustrated, reads “successful contact” whichmay be an automatically generated note or an example of standard notecontent. As illustrated, in addition to the note, the user interface 300includes addition or upload of a vehicle crash report and associatedvehicle photos 302. The vehicle crash report is another example ofunstructured data. Each of the claim note 304 and the vehicle report andphotos 302 may be associated with an entry date 306. Informationregarding a user logged into the user interface 300 may also beassociated with the claim note 304 and the vehicle report and photos302.

Returning to FIG. 1 , the format clustering engine 116 may coordinatewith a format parsing engine 126 to parse and characterize formattingaspects of the unstructured data portion. The format parsing engine 126,in some examples, may identify patterns in and/or counts of whitespaceuse (tabs and spaces), carriage returns, bullets, and/or number ofcharacters between bullets and/or carriage returns. For Englishdocuments, for example, the format parsing engine 126 may parse thedocuments from left to right and top down. The format parsing engine 126may provide a set of formatting data representing the identifiedpatterns and/or counts to the format clustering engine 116.

Using the set of formatting data from the format parsing engine 126, insome implementations, the format clustering engine 116 applies one ormore clustering algorithms to match the set of formatting data with apreexisting cluster. For example, clusters provided by a firstclustering algorithm may be supplied to a second clustering algorithm toproduce more fine-grained cluster information. In another example,different clustering algorithms with different goals (e.g., whitespaceclusters vs. bullet and list type formatting clusters) may be executedsequentially or in parallel to analyze the set of formatting data. Thepreexisting clusters, for example represented by cluster data 154,represent other unstructured data portions suspected of containingsimilar information based on formatting similarity. The clusteringalgorithm(s), for example, may include agglomerative clustering,density-based spatial clustering of applications with noise (DBSCAN), orfast density peak clustering (DPeak). The clustering algorithm(s) mayadditionally consider a distance measure or similarity metric,representing the distance between the formatting of pairs ofunstructured data portions and/or the distance between an unstructureddata portion and the formatting data of a preexisting cluster. Thedistance measure may be a Euclidean or cosine distance, for example. Inillustration, the distance measure can be varied to identify identical(e.g., standard formatted) notes, highly similar (e.g., templateformatted) notes, or closely resembling (e.g., department ororganizational trained style) notes on a particular topic. The formatclustering engine 116, in some implementations, associates a particularcluster or limited set of clusters within the cluster data 154 matchingthe unstructured data portion based upon similarity metric(s) with theunstructured data portion. In other implementations, the formatclustering engine 116 may return identifiers of one or more formattingclusters to the unstructured data processing engine 114.

In some implementations, the unstructured data processing engine 114provides the unstructured data portion(s) to a sentence clusteringengine 118 for sentence text analysis. The text of unstructured dataportion(s), for example, may be useful in identifying events or actions.The sentence clustering engine 118 may coordinate with a sentenceparsing engine 128 to parse the text of the unstructured data portion.

In some embodiments, the sentence parsing engine 128 separates out eachsentence of the unstructured data portion. For example, a “sentence” maybe determined through punctuation or through text and/or formattinganalysis to identify a “blurb” (e.g., a list of notes including bullets,etc.). The sentence parsing engine 128, for example, may apply atokenizer to separate the unstructured data portion into sentences.Further, in some embodiments, for each sentence of the unstructured dataportion, the sentence parsing engine 128 identifies terms and/or phrasesand counts of each individual term and/or phrase within the sentence.The phrases may include common phrases used by claims handlers, medicalprofessionals, law enforcement officers, vehicle inspectors, and/orothers providing claims documentation. The sentence parsing engine 128may provide a sentence data set including the term and/or phrase countsto the sentence clustering engine 118.

In some embodiments, text portions other than sentences are parsed bythe sentence parsing engine 128 to determine a different or additionaltext data set for evaluation by the sentence clustering engine 118 oranother clustering engine. In one example, terms in the unstructureddata portion may be converted into vectors to identify synonyms. Inanother example, a set of topics may be identified within theunstructured data portion. Topics analysis, in an illustrative example,may be useful in identifying various topics captured in claim-relatedlegal documents 150 or other structured reports including a set oftopics.

Using the set of sentences from the sentence parsing engine 128, in someimplementations, the sentence clustering engine 118 applies one or moreclustering algorithms to match the set of sentences with a preexistingcluster. For example, clusters provided by a first clustering algorithmmay be supplied to a second clustering algorithm to produce morefine-grained cluster information. In another example, differentclustering algorithms with different goals (e.g., similar meaning termsclusters vs. phrase matching clusters) may be executed sequentially orin parallel to analyze the set of formatting data. The preexistingclusters, for example represented by the cluster data 154, representother sentences suspected of containing similar information based onsentence term and/or phrasing similarity. The clustering algorithm(s),for example, may include agglomerative clustering, density-based spatialclustering of applications with noise (DBSCAN), or fast density peakclustering (DPeak). The clustering algorithm(s) may additionallyconsider a distance measure or similarity metric, representing thedistance between the formatting of the unstructured data portion and theformatting represented by a given cluster. The distance measure may be aEuclidean or cosine distance, for example. In illustration, the distancemeasure can be varied to identify identical (e.g., standard formatted)notes, highly similar (e.g., template formatted) notes, or closelyresembling (e.g., department or organizational trained style) notes on aparticular topic. The sentence clustering engine 118, in someimplementations, associates a particular cluster or limited set ofclusters within the cluster data 154 matching each sentence of theunstructured data portion based upon similarity metric(s) with theparticular sentence of the unstructured data portion. In otherimplementations, the sentence clustering engine 118 may returnidentifiers of one or more sentence clusters to the unstructured dataprocessing engine 114.

In some implementations, the unstructured data processing engine 114associates the unstructured data portion with the sentence clusteridentifier(s) and the formatting cluster identifier(s). For example, theunstructured data portion (e.g., claim-related note 148, claim-relatedlegal document 150, or claim-related handwritten document 152) may beassociated with cluster data 154 within the data repository 110.

In other implementations, the unstructured data processing engine 114provides the sentence cluster identifier(s) and the formatting clusteridentifier(s) to an automatic labeling engine 120 to label theunstructured data portion with a selected label of a set of label data156. The label data 156, in some illustrative examples, can include aliability analysis label, a contact with the insured label, a policereport label, a receipt label, a medical record label, and/or anautomobile inspection report label. The automatic labeling engine 120,for example, may label the unstructured data portion according to atleast a portion of the sentence cluster identifier(s) and/or theformatting cluster identifier(s).

The automatic labeling engine 120, in some implementations, appliesmachine learning analysis to assign a label of the label data 156 toeach unstructured data portion according to the sentence clusteridentifier(s) and/or the formatting cluster identifier(s). For example,the automatic labeling engine 120 may provide the sentence clusteridentifier(s) and/or the formatting cluster identifier(s) to a machinelearning analysis engine 134.

In some implementations, the machine learning analysis engine 134applies machine learning models. Each machine learning model may betrained to identify documents conforming to a label or set of labels ofthe label data according to at least a portion of the sentence clusteridentifier(s) and/or the formatting cluster identifier(s). The machinelearning models, for example, may have been trained via a trainingengine 132 designed to obtain truth data (e.g., manual confirmation orconfirmation via derived information such as metadata components) ofappropriate labeling of unstructured data. Further, certain models maybe developed to analyze certain types of unstructured data, such asclaim-related notes 148, claim-related legal documents 150, and/orclaim-related handwritten materials 152.

Individual machine learning models of the machine learning analysisengine 134, in some implementations, further apply document metadata 160and/or other metrics in analyzing the cluster identifiers of theunstructured data portions. As described above, if the original documentformatting of the unstructured data portion included a metadata portion,the metadata may be retained as document metadata 160 associated withthe unstructured data portion. The document metadata 160, in someexamples, may include author and/or editor information, date information(e.g., original date, edited date, etc.), and/or location information(e.g., location at which a report of vehicle damage was obtained). Dateinformation, in illustration, may be useful in identifying a processingphase of a set of processing phases 162 of the claims processing cycleat which the unstructured data portion was created or added to theclaims data, while author or editor information may be useful inmatching the unstructured data portion to a claimant record of claimantdata 140 or a claims handler record of processing agent data 146. Asillustrated in FIG. 3 , the vehicle photos 302, for example, may includemetadata identifying a date and/or location of capture.

In some implementations, a metrics engine 124 associates metrics withthe unstructured data portion. The machine learning analysis engine 134,for example, may access metrics related to the unstructured data portionthrough the metrics engine 124. The metrics engine 124, in someexamples, may identify a claims handler of the processing agent data 146associated with the claim corresponding to the unstructured dataportion, an employee level (e.g., agent, supervisor, etc.) of an authorof the unstructured data portion, a claim status of claim status data144, an open processing action of a set of processing actions 166, oneor more closed processing actions of the set of processing actions 166,a length of time since claim initiation, one or more processingmilestones of a set of processing milestones 164 associated with theclaim, a type of claim and/or severity of the claim, a number of partiesto the claim, and/or information regarding parties to the claim fromclaimant data 140. In some embodiments, the metrics engine 124identifies other unstructured data portions associated with the sameclaim. A portion of the metrics, such as the type of claim and aninitiation date, may be accessed from structured claims data 142 of thedata repository 110. Further, a portion of the metrics, such as thelength of time since claim initiation and/or the severity of the claim,may be derived from the structured claims data 142. For example, theseverity of the claim may be determined through natural languageprocessing of a loss description.

In some implementations, the machine learning engine 134 determines acorresponding label for the unstructured data portion within a thresholdlevel of confidence. The threshold level of confidence, for example, maybe programmed into tuning parameters of the machine learning models. Themachine learning engine 134 may associate the label with theunstructured data portion or provide the label to the unstructured dataprocessing engine 114 for further processing.

Certain labels of the label data 156 may be associated with processingactions 166 and/or processing milestones 164. In some implementations,the unstructured data processing engine 114 analyzes the assigned labelin view of the structured claims data 142 and/or other metrics (e.g.,generated by the metrics engine 124) to confirm appropriate handling ofprocessing actions 166 and/or processing milestones 164 in accordancewith the assigned label. If the label corresponding to the unstructureddata portion represents a processing action or processing milestone thateither needs to be implemented or appears to have missed beingimplemented in a timely manner in accordance with the metrics associatedwith the unstructured data portion, in some embodiments, theunstructured data processing engine 114 alerts an action assignmentengine 122 so that an action can be assigned to one of the claimsprocessing agents 108 or another client 104 (e.g., supervisor, etc.) forhandling.

Certain labels of the label data 156 may be associated with predictedclaim outcomes. In some implementations, the unstructured dataprocessing engine 114 analyzes the assigned label in view of thestructured claims data 142 and/or other metrics (e.g., generated by themetrics engine 124) to identify aspects of interest of a claim such as,in some examples, a total cost for the claim, a length in time of claimhandling, the outcome of attorney oversight (e.g., settlement,arbitration, law suit, etc.), or a document length of one or moredocuments of the claim.

The machine learning engine 134, in some circumstances, may fail toidentify a label corresponding to a particular unstructured dataportion. In this circumstance, in some implementations, the machinelearning engine 134 may provide information to a manual action reviewengine 130 to obtain manual labeling of the unstructured data portion.For example, a contact or group of contacts may be emailed, texted, orotherwise alerted of a failure to match the unstructured data portion ofa label of the label data 156, resulting in manual label application.The manual review engine 130 may, in turn, identify the manual labelinformation and corresponding unstructured data portion to the trainingengine 132 to automatically refine one or more machine learning modelsin accordance with the new truth data.

FIGS. 2A through 2C illustrate flow charts of an example method 200 andsub-methods for assigning unstructured data portions to clusters andthen assigning a label based on the clusters. The methods, for example,may be performed by various engines of the claims processing platform102 of FIG. 1 .

Turning to FIG. 2A, in some implementations, the method 200 begins withaccessing unstructured data related to at least one claim of a set ofinsurance claims 202). The unstructured data, for example, may beretained in one or more data sources, such as the data repository 110 ofFIG. 1 . The unstructured data processing engine 114 may access theunstructured data.

In some implementations, metadata and/or metrics related to eachdiscrete portion of the unstructured data is identified (204). Themetadata and/or metrics, in some examples, may provide informationrelevant to the purpose, origination, and/or position in the claimsprocessing timeline (e.g., according to processing milestones 164 and/orprocessing phases 162, as discussed in relation to FIG. 1 ).

Turning to FIG. 2B, an example method 230 for identifying supplementaldata (e.g., metadata and/or metrics, etc.) related to discrete dataportions is provided. Portions of the method 230, for example, may beperformed by the unstructured data processing engine 114 and/or themetrics engine 124 of FIG. 1 .

In some implementations, the method 230 begins with determining a typeof a discrete portion of unstructured data (232). The type, in someembodiments, is determined in part based on a storage location of theunstructured data portion. In some embodiments, the type is determinedin part by the document type or file name extension (e.g., .txt, .doc,.pdf, .gif, etc.).

If the type is a claim agent note (234), in some implementations, aclaim agent identifier representing the author of the note and/or anemployee level of the author is associated with the unstructured dataportion. The claim agent identifier and/or employee level, for example,may be cross-referenced in processing agent data 146. Associating theagent identifier and/or employee level with the unstructured dataportion, for example, can include creating a database or logical linkbetween the unstructured data portion and the processing agentinformation. In another example, the claim agent identifier and/oremployee level may be added to document data 158 of the unstructureddata portion (FIG. 1 ).

In some implementations, if the type of the unstructured data portion isa claim agent note, one or more milestones, events, and/or actions inclaim handling that occurred (or were completed) prior to entry of thediscrete portion are determined (238). For example, the milestones mayinclude initial contact, property inspection, and/or resolution. Themilestones may be determined, for example, based upon claim status data144 and/or structured claims data 142, as illustrated in FIG. 1 .

In some implementations, based on any milestones, events, and/or actionsdetermined (238), a processing phase, prior action(s), and/or length ofelapsed time is associated with the discrete portion (240). For example,an elapsed time between a most recent milestone, event, and/or action(e.g., opening of the claim) and the entry of the claim agent note maybe calculated. In another example, a prior action (e.g., initialcontact) may be associated with the claim agent note.

If the type of the discrete portion of unstructured data is, instead, alegal document (242), in some implementations, information is derivedfrom text of the legal document such as, in some examples, one or moreparties (e.g., companies, entities, and/or individuals) to a conflict oragreement, a type of legal document (e.g., insurance contract, rentalcontract, licensing terms, etc.), context surrounding the legaldocument, a goal of the legal document, and/or one or more datesassociated with the legal document, such as an execution date or aperformance date. The legal document, in some embodiments, is a standardform used by the claims processing platform 102 of FIG. 1 . In thiscircumstance, the information may be derived by extracting informationfrom set locations within the standard form. In other embodiments, thelegal document is analyzed using natural language processing to obtainat least a portion of the information. A manual review may be flagged toinsert missing information and/or to confirm automatically derivedinformation. For example, the manual review engine 130 of FIG. 1 mayschedule a manual review by a processing agent.

If the type of discrete portion of unstructured data includes metadata(246), in some implementations, the metadata is associated with theunstructured data portion (248). For example, the unstructured dataprocessing engine 114 of FIG. 1 may store the metadata as documentmetadata 160.

In some implementations, the method 230 continues for each additionalunstructured data portion (250).

Returning to FIG. 2A, in some implementations, formatting of thediscrete portion of unstructured data is parsed (206). Format parsing,for example, may be performed as discussed in relation to the formatparsing engine 126 of FIG. 1 .

In some implementations, a format cluster is determined for the discreteportion of the unstructured data (208). The format cluster, for example,may be determined as discussed in relation to the format clusteringengine 116 of FIG. 1 .

In some implementations, individual sentences are parsed out of thediscrete portion of the unstructured data (210). For example, thesentences may be parsed as described in relation to the sentence parsingengine 128 of FIG. 1 .

In some implementations, the format cluster determined at step 208 isassigned to each sentence (212). The format cluster, for example, may beassociated to each sentence parsed out of the unstructured data portion.

In some implementations, a sentence cluster is determined (214) for eachsentence (216) of the unstructured data portion. The sentence cluster,for example, may be determined in a manner described in relation to thesentence clustering engine 118 of FIG. 1 .

In some implementations, the cluster determinations are analyzed toassign a label to the unstructured data portion (218). The clusterdeterminations may be analyzed, for example, as described in relation toFIG. 2C.

Turning to FIG. 2C a flow chart of an example method 260 for analyzingcluster assignments to automatically label unstructured data portions ispresented. Portions of the method 260, for example, may be performed bythe claims processing platform 102 of FIG. 1 .

In some implementations, the method 260 begins with accessing clusterinformation including the format cluster and the sentence cluster(s)assigned to a discrete portion of unstructured data (262). The clusterinformation, for example, may be accessed from the cluster data 154 ofthe data repository 110 of FIG. 1 . The automatic labeling engine 120,in some embodiments, accesses the cluster information.

In some implementations, if the assigned format cluster is associatedwith a preexisting label (264) it is determined if the label agrees withmetadata and/or metrics of the discrete portion (266). For example,document metadata 160 and/or document metrics (e.g., as described inrelation to the metrics engine 124 of FIG. 1 ) may be analyzed in viewof the preexisting label to confirm the preexisting label does notconflict in context with the metadata and/or metrics. For example, thelabel may relate to a police report, while the meta data identifies thedocument as a report provided by a vehicle repair shop. The preexistinglabel (264), in some implementations, is applied to the discrete portionof unstructured data (268). The label, for example, may be applied bythe automatic labeling engine 120 by associating label data 156 with thedocument data 158.

In some implementations, if the label does not agree with the metadataand/or metrics of the discrete portion (266), similarities areidentified between the format cluster(s) of the discrete portion ofunstructured data and one or more labeled format clusters (280). In oneexample, the similarity may be identified using a distance function,such as Euclidean distance or cosine distance. The similarities, inanother example, may be identified by a trained classification algorithm(e.g., machine learning classifier).

In some implementations, metadata and/or metrics are applied to identifythe most similar cluster (282) out of two or more similar labeled formatclusters identified at step 280. One or more classification algorithms,for example, may be trained to use the similarity of the clustersthemselves and the metadata and/or metrics to determine the most similarcluster. If, conversely, only one similar labeled format cluster wasidentified, step 282 may be skipped.

In some implementations, the label of the most similar labeled formatcluster is proposed as an appropriate label for the unstructured dataportion (284). In some embodiments, proposing the label includesproviding, via electronic communication, the label for review by aprocessing agent 108 of FIG. 1 or other member of the claims processingplatform. For example, the proposed label and associated information maybe made accessible to a user via a text message, email, or electronicmessaging system in an interactive graphical interface supplied by theclaims processing platform 102 of FIG. 1 . In another example, the labelmay be added to a review queue for review by a selected user or group ofusers. In other embodiments, the label may be tentatively applied to theunstructured data portion with a flag for further review (e.g., for bulkmanual review). For example, the label may be distinguished with agraphic, color-coding, or other visual marking such that a user may beled to double check the information.

Returning to step 264, in some implementations, if the format cluster isnot associated with a label (264), it is determined whether the discreteportion of unstructured data is associated with more than one sentencecluster (272). If there is only one associated sentence cluster (274)and the sentence cluster is associated with a label (274), in someimplementations, the method 260 follows the path of determining whetherthe label agrees with the metadata and/or metrics of the discreteportion (266) as described above.

In some implementations, if there is only one sentence cluster (272) andthe cluster is not associated with a label (274), the method 260 followsthe path beginning with identifying similarities between the sentencecluster and labeled sentence clusters (280).

If, instead, there is more than one sentence cluster associated with theunstructured data portion (272), and the sentence clusters areassociated with a single label (e.g., only one of the sentence clustersis labeled, or two or more sentence clusters have the same label) (276),in some implementations, the method 260 follows the path of determiningwhether the label agrees with the metadata and/or metrics of thediscrete portion (266) as described above.

Conversely, if there is more than one sentence cluster associated withthe unstructured data portion (272), and the sentence clusters areassociated with two or more labels, the method 260 follows the pathbeginning with identifying similarities between the sentence cluster andlabeled sentence clusters (280).

In some implementations, the method 260 repeats (270) for eachadditional discrete portion of unstructured data.

Returning to FIG. 2A, in some implementations, if additional discreteportions of unstructured data are available for processing (220), a nextdiscrete portion of unstructured data is accessed (222), and the method200 returns to parsing the formatting of the discrete portion ofunstructured data (206).

Turning to FIG. 4 , a flow diagram illustrates a process 400 fortraining vulnerability detection data models using information derivedfrom both structured and unstructured data portions. In someimplementations, claim notes 402 and other unstructured data 404 areextracted from closed insurance claims (e.g., for a given insuranceprovider or set of insurance providers) and used in combination withhistorical loss run data 412 to train a diagnostic data model 416 (e.g.,for each provider or for providers in general). The loss run data 412,in some examples, may include loss amounts for indemnity, medical,reserve, and total losses, loss types, and a salvage total.

In some implementations, an unstructured data processor 406 analyzes theclaim notes 402 and the other unstructured data 404 to determine labeldata 408 and metadata and/or metrics 410 associated with each type ofunstructured data 402 and 404. The unstructured data processor 406, forexample, may perform at least a portion of the analysis described inrelation to the unstructured data processing engine 114 and relatedengines of the claims processing platform 102, as described in relationto FIG. 1 . The unstructured data processor 406, for example, mayperform at least a portion of the method 200 and its sub-methods 230and/or 260, as described in relation to FIG. 2A to FIG. 2C.

In some implementations, the label data 408, metadata and/or metrics410, and loss run data 412 are used by a diagnostic data model trainingmodule 414 to train the diagnostic data model 416. The diagnostic datamodel 416 may be trained to output a probability of an occurrence of aclaim handling violation or other vulnerability in each phase ofinsurance claim processing. For example, the output of the diagnosticdata model 416 may represent in a probabilistic manner the phases of theclaim handling process that are likely to have violations or othervulnerabilities. By combining the label data 408 and metadata and/ormetrics 410 with the original loss run data 412, for example, thediagnostic data model training module 414 may develop the diagnosticdata model 416 by removing bias from the loss run data 412 whileenlarging the data set used to train the diagnostic data model 416.

Next, a hardware description of the computing device, mobile computingdevice, or server according to exemplary embodiments is described withreference to FIG. 5 . The computing device, for example, may representthe clients 104, the claims data sources 106, the claims processingagents 108, or one or more computing systems supporting thefunctionality of the claims processing platform 102, as illustrated inFIG. 1 . In FIG. 5 , the computing device, mobile computing device, orserver includes a CPU 500 which performs the processes described above.The process data and instructions may be stored in memory 502. Theprocessing circuitry and stored instructions may enable the computingdevice to perform, in some examples, the methods 200, 230, and 260 ofFIGS. 2A-2C and/or the process 400 of FIG. 4 . These processes andinstructions may also be stored on a storage medium disk 504 such as ahard drive (HDD) or portable storage medium or may be stored remotely.Further, the claimed advancements are not limited by the form of thecomputer-readable media on which the instructions of the inventiveprocess are stored. For example, the instructions may be stored on CDs,DVDs, in FLASH memory, RAM, ROM, PROM, EPROM, EEPROM, hard disk or anyother information processing device with which the computing device,mobile computing device, or server communicates, such as a server orcomputer. The storage medium disk 504, in some examples, may store thecontents of the data repository 110 of FIG. 1 .

Further, a portion of the claimed advancements may be provided as autility application, background daemon, or component of an operatingsystem, or combination thereof, executing in conjunction with CPU 500and an operating system such as Microsoft Windows, UNIX, Solaris, LINUX,Apple MAC-OS and other systems known to those skilled in the art.

CPU 500 may be a Xenon or Core processor from Intel of America or anOpteron processor from AMD of America, or may be other processor typesthat would be recognized by one of ordinary skill in the art.Alternatively, the CPU 500 may be implemented on an FPGA, ASIC, PLD orusing discrete logic circuits, as one of ordinary skill in the art wouldrecognize. Further, CPU 500 may be implemented as multiple processorscooperatively working in parallel to perform the instructions of theinventive processes described above.

The computing device, mobile computing device, or server in FIG. 5 alsoincludes a network controller 506, such as an Intel Ethernet PRO networkinterface card from Intel Corporation of America, for interfacing withnetwork 528. As can be appreciated, the network 528 can be a publicnetwork, such as the Internet, or a private network such as an LAN orWAN network, or any combination thereof and can also include PSTN orISDN sub-networks. The network 528 can also be wired, such as anEthernet network, or can be wireless such as a cellular networkincluding EDGE, 3G, 4G, and 5G wireless cellular systems. The wirelessnetwork can also be Wi-Fi, Bluetooth, or any other wireless form ofcommunication that is known. The network 528, for example, may supportcommunications between the claims processing system 102 and any one ofthe clients 104, claims data sources 106, and claims processing agents108.

The computing device, mobile computing device, or server furtherincludes a display controller 508, such as a NVIDIA GeForce GTX orQuadro graphics adaptor from NVIDIA Corporation of America forinterfacing with display 510, such as a Hewlett Packard HPL2445w LCDmonitor. A general purpose I/O interface 512 interfaces with a keyboardand/or mouse 514 as well as a touch screen panel 516 on or separate fromdisplay 510. General purpose I/O interface 512 also connects to avariety of peripherals 518 including printers and scanners, such as anOfficeJet or DeskJet from Hewlett Packard. The display controller 508and display 510 may enable presentation of the user interfaceillustrated, for example, in FIG. 3 .

A sound controller 520 is also provided in the computing device, mobilecomputing device, or server, such as Sound Blaster X-Fi Titanium fromCreative, to interface with speakers/microphone 522 thereby providingsounds and/or music.

The general purpose storage controller 524 connects the storage mediumdisk 504 with communication bus 526, which may be an ISA, EISA, VESA,PCI, or similar, for interconnecting all of the components of thecomputing device, mobile computing device, or server. A description ofthe general features and functionality of the display 510, keyboardand/or mouse 514, as well as the display controller 508, storagecontroller 524, network controller 506, sound controller 520, andgeneral purpose I/O interface 512 is omitted herein for brevity as thesefeatures are known.

One or more processors can be utilized to implement various functionsand/or algorithms described herein, unless explicitly stated otherwise.Additionally, any functions and/or algorithms described herein, unlessexplicitly stated otherwise, can be performed upon one or more virtualprocessors, for example on one or more physical computing systems suchas a computer farm or a cloud drive.

Reference has been made to flowchart illustrations and block diagrams ofmethods, systems and computer program products according toimplementations of this disclosure. Aspects thereof are implemented bycomputer program instructions. These computer program instructions maybe provided to a processor of a general purpose computer, specialpurpose computer, or other programmable data processing apparatus toproduce a machine, such that the instructions, which execute via theprocessor of the computer or other programmable data processingapparatus, create means for implementing the functions/acts specified inthe flowchart and/or block diagram block or blocks.

These computer program instructions may also be stored in acomputer-readable medium that can direct a computer or otherprogrammable data processing apparatus to function in a particularmanner, such that the instructions stored in the computer-readablemedium produce an article of manufacture including instruction meanswhich implement the function/act specified in the flowchart and/or blockdiagram block or blocks.

The computer program instructions may also be loaded onto a computer orother programmable data processing apparatus to cause a series ofoperational steps to be performed on the computer or other programmableapparatus to produce a computer implemented process such that theinstructions which execute on the computer or other programmableapparatus provide processes for implementing the functions/actsspecified in the flowchart and/or block diagram block or blocks.

Moreover, the present disclosure is not limited to the specific circuitelements described herein, nor is the present disclosure limited to thespecific sizing and classification of these elements. For example, theskilled artisan will appreciate that the circuitry described herein maybe adapted based on changes on battery sizing and chemistry or based onthe requirements of the intended back-up load to be powered.

The functions and features described herein may also be executed byvarious distributed components of a system. For example, one or moreprocessors may execute these system functions, wherein the processorsare distributed across multiple components communicating in a network.The distributed components may include one or more client and servermachines, which may share processing, as shown on FIG. 6 , in additionto various human interface and communication devices (e.g., displaymonitors, smart phones, tablets, personal digital assistants (PDAs)).The network may be a private network, such as a LAN or WAN, or may be apublic network, such as the Internet. Input to the system may bereceived via direct user input and received remotely either in real-timeor as a batch process. Additionally, some implementations may beperformed on modules or hardware not identical to those described.Accordingly, other implementations are within the scope that may beclaimed.

In some implementations, the described herein may interface with a cloudcomputing environment 630, such as Google Cloud Platform™ to perform atleast portions of methods or algorithms detailed above. The processesassociated with the methods described herein can be executed on acomputation processor, such as the Google Compute Engine by data center634. The data center 634, for example, can also include an applicationprocessor, such as the Google App Engine, that can be used as theinterface with the systems described herein to receive data and outputcorresponding information. The cloud computing environment 630 may alsoinclude one or more databases 638 or other data storage, such as cloudstorage and a query database. In some implementations, the cloud storagedatabase 638, such as the Google Cloud Storage, may store processed andunprocessed data supplied by systems described herein. For example,various data represented as being stored in data repository 110 of FIG.1 , such as, in some examples, the claimant data 140, the structuredclaims data 142, the claim status data 144, the processing agent data146, the claim-related notes 148, the claim-related legal documents 150,the claim-related handwritten materials 152, the cluster data 154, thelabel data 156, the document data 158, the document metadata 160, theprocessing phases 162, the processing milestones 164, and/or theprocessing actions 166 may be stored in a database structure such as thedatabases 638.

The systems described herein may communicate with the cloud computingenvironment 630 through a secure gateway 632. In some implementations,the secure gateway 632 includes a database querying interface, such asthe Google BigQuery platform. The data querying interface, for example,may support access by the claims processing platform 102 (e.g., theunstructured data processing engine 114, training engine 132, and/ormachine learning analysis engine 134) to data stored on any one of theclients 104 or claim data sources 106.

The cloud computing environment 630 may include a provisioning tool 640for resource management. The provisioning tool 640 may be connected tothe computing devices of a data center 634 to facilitate the provisionof computing resources of the data center 634. The provisioning tool 640may receive a request for a computing resource via the secure gateway632 or a cloud controller 636. The provisioning tool 640 may facilitatea connection to a particular computing device of the data center 634.

A network 602 represents one or more networks, such as the Internet,connecting the cloud environment 630 to a number of client devices suchas, in some examples, a cellular telephone 610, a tablet computer 612, amobile computing device 614, and a desktop computing device 616. Thenetwork 602 can also communicate via wireless networks using a varietyof mobile network services 620 such as Wi-Fi, Bluetooth, cellularnetworks including EDGE, 3G, 4G, and 5G wireless cellular systems, orany other wireless form of communication that is known. In someexamples, the wireless network services 620 may include centralprocessors 622, servers 624, and databases 626. In some embodiments, thenetwork 602 is agnostic to local interfaces and networks associated withthe client devices to allow for integration of the local interfaces andnetworks configured to perform the processes described herein.Additionally, external devices such as the cellular telephone 610,tablet computer 612, and mobile computing device 614 may communicatewith the mobile network services 620 via a base station 656, accesspoint 654, and/or satellite 652.

While certain embodiments have been described, these embodiments havebeen presented by way of example only, and are not intended to limit thescope of the present disclosures. Indeed, the novel methods, apparatusesand systems described herein can be embodied in a variety of otherforms; furthermore, various omissions, substitutions and changes in theform of the methods, apparatuses and systems described herein can bemade without departing from the spirit of the present disclosures. Theaccompanying claims and their equivalents are intended to cover suchforms or modifications as would fall within the scope and spirit of thepresent disclosures.

What is claimed is:
 1. A system for constructing a vulnerability datamodel based on automated analysis of data corresponding to a set ofclosed insurance claims, the system comprising: a plurality ofpre-defined clusters, each cluster representing a grouping of naturallanguage processing analysis results corresponding to a respective labelof a set of pre-defined labels; and processing circuitry configured toperform a plurality of operations, the operations comprising, for eachgiven claim of a set of closed insurance claims, accessing loss run datafor the given claim and a plurality of unstructured-data portionsassociated with the given claim, including one or more unstructured-dataportions representing data entry by one or more individuals associatedwith the given claim, for each given data portion of the accessedplurality of unstructured-data portions, applying an unstructured-dataprocessor to the given data portion to identify, for the given dataportion, a selected term cluster of the plurality of pre-definedclusters providing a closest match to a textual analysis of the givendata portion, and associating, with the given data portion, thepre-defined label corresponding to the selected term cluster, andsupplying, to a diagnostic data training module, the accessed loss rundata, the pre-defined labels associated with each data portion of theaccessed plurality of unstructured-data portions, and metadataassociated with at least a subset of the plurality of accessedunstructured-data portions, and determining, by the diagnostic datatraining module and based on the loss run data, the pre-defined labels,and the metadata supplied to the diagnostic data training module foreach claim of the set of closed insurance claims, a vulnerability modeldescribing a probability of occurrence of one or more vulnerabilitytypes during each phase of a plurality of phases of insurance claimprocessing.
 2. The system of claim 1, wherein the operations furthercomprise: accessing, for one or more of the set of closed insuranceclaims, structured claim note data; and supplying the structured claimnote data for use in determining the vulnerability model.
 3. The systemof claim 1, wherein the loss run data for each respective claim of theset of closed insurance claims comprises one or more of a loss amountfor indemnity, a medical cost, a reserve amount, a total of losses forthe respective claim, an indication of one or more loss types for therespective claim, and a salvage total.
 4. The system of claim 1, whereinthe unstructured-data processor applies a textual analysis to the givendata portion using operations comprising: applying natural languageprocessing to a text component of the given data portion to obtain a setof term counts of words and/or phrases identified in the text component;and applying at least one clustering algorithm to the set of term countsto determine a term cluster for the text component.
 5. The system ofclaim 1, wherein each label of at least a portion of the set ofpre-defined labels relates to at least one of a type of content in anunstructured-data portion or a type of action taken by an individualassociated with the unstructured-data portion.
 6. The system of claim 1,wherein identifying the selected term cluster providing the closestmatch comprises identifying the selected term cluster providing theclosest match in view of a metadata component of the given data portion.7. The system of claim 6, wherein identifying the selected term clusterin view of the metadata component comprises determining whetherinformation of the metadata component conflicts with a context of thepre-defined label corresponding to the selected term cluster providingthe closest match.
 8. The system of claim 6, wherein the metadatacomponent comprises at least one of an author, an editor, dateinformation, or location information.
 9. The system of claim 6, whereinidentifying the selected term cluster in view of the metadata componentcomprises accessing one or more metrics corresponding to one or moreelements of the metadata component.
 10. The system of claim 9, whereinthe one or more metrics comprises one or more of a user identifier, anemployee level, a processing phase, a prior action, a length of elapsedtime, or a party to a legal document.
 11. A method for constructing avulnerability data model based on automated analysis of datacorresponding to a set of closed insurance claims, the methodcomprising: accessing, by processing circuitry from a non-transitorycomputer readable medium, a plurality of pre-defined clusters, eachcluster representing a grouping of natural language processing analysisresults corresponding to a respective label of a set of pre-definedlabels; and for each given claim of a set of closed insurance claims,accessing, by the processing circuitry, loss run data for the givenclaim and a plurality of unstructured-data portions associated with thegiven claim, including one or more unstructured-data portionsrepresenting data entry by one or more individuals associated with thegiven claim, and for each given data portion of the accessed pluralityof unstructured-data portions, applying, by the processing circuitry,unstructured-data processing to the given data portion to identify, forthe given data portion, a selected term cluster of the plurality ofpre-defined clusters providing a closest match to a textual analysis ofthe given data portion, and associating with the given data portion, bythe processing circuitry, the pre-defined label corresponding to theselected term cluster, and supplying, to a diagnostic data trainingmodule, the accessed loss run data, the pre-defined labels associatedwith each data portion of the accessed plurality of unstructured-dataportions, and metadata associated with at least a subset of theplurality of accessed unstructured-data portions; and determining, bythe diagnostic data training module and based on the loss run data, thepre-defined labels, and the metadata supplied to the diagnostic datatraining module for each claim of the set of closed insurance claims, avulnerability model describing a probability of occurrence of one ormore vulnerability types during each phase of a plurality of phases ofinsurance claim processing.
 12. The method of claim 11, furthercomprising: accessing, by the processing circuitry for one or more ofthe set of closed insurance claims, structured claim note data; andsupplying the structured claim note data for use in determining thevulnerability model.
 13. The method of claim 11, wherein the loss rundata for each respective claim of the set of closed insurance claimscomprises one or more of a loss amount for indemnity, a medical cost, areserve amount, a total of losses for the respective claim, anindication of one or more loss types for the respective claim, and asalvage total.
 14. The method of claim 11, wherein applying theunstructured-data processing comprises applying a textual analysis tothe given data portion using operations comprising: applying naturallanguage processing to a text component of the given data portion toobtain a set of term counts of words and/or phrases identified in thetext component; and applying at least one clustering algorithm to theset of term counts to determine a term cluster for the text component.15. The method of claim 14, further comprising parsing, by theprocessing circuitry, individual sentences of the unstructured-dataportion, wherein: obtaining the set of term counts comprises obtaining arespective set of term counts of each sentence of one or more sentencesof the unstructured-data portion; and applying the at least oneclustering algorithm comprises applying the at least one clusteringalgorithm to each sentence of the one or more sentences.
 16. The methodof claim 11, wherein each label of at least a portion of the set ofpre-defined labels relates to at least one of a type of content in anunstructured-data portion or a type of action taken by an individualassociated with the unstructured-data portion.
 17. The method of claim11, wherein identifying the selected term cluster providing the closestmatch comprises identifying the selected term cluster providing theclosest match in view of a metadata component of the given data portion.18. The method of claim 17, wherein identifying the selected termcluster in view of the metadata component comprises determining whetherinformation of the metadata component conflicts with a context of thepre-defined label corresponding to the selected term cluster providingthe closest match.
 19. The method of claim 17, wherein identifying theselected term cluster in view of the metadata component comprisesaccessing one or more metrics corresponding to one or more elements ofthe metadata component.
 20. The method of claim 19, wherein the one ormore metrics comprises one or more of a user identifier, an employeelevel, a processing phase, a prior action, a length of elapsed time, ora party to a legal document.